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R. Laney Owings, PharmD, BCPS, BCPP
Psychiatric Clinical Pharmacy Specialist|
University of North Carolina Health
Chapel Hill, NC
Caroline Sutton, PharmD, BCPS
Neurology Clinical Pharmacy Specialist
University of North Carolina Health
Chapel Hill, NC
Hope Randle, PharmD, BCPS
Psychiatric Clinical Pharmacy Specialist
Western State Hospital
Tacoma, WA

During the COVID-19 pandemic, hospitals and learning institutions across the nation had to pivot from in-person instruction, rounding, patient care, and conventional methods of meeting residency goals. This lunge into previously uncharted territory inspired the creative and innovative use of pre-existing tools to reduce exposure and flatten the curve, while not compromising learning experiences.

At the University of North Carolina Medical Center (UNCMC), pharmacy residents shifted from on-site to virtual work on Tuesday, March 17, 2020. Virtual rounding was implemented via an encrypted video conferencing system. The pharmacy resident completing an inpatient geriatric psychiatry rotation contacted physicians and staff via phone or used the HIPAA-compliant messaging system within the electronic medical record (EMR) to discuss patients and make recommendations. Additionally, this resident co-precepted two pharmacy students virtually. The resident video conferenced with students before rounds to review patients and used the EMR messaging system during rounds to communicate. After rounds, learners and preceptors would video conference to conduct topic discussions and patient presentations. The second pharmacy resident rotated through an outpatient pain clinic rotation when the shift to virtual work occurred. Daily workflow included a virtual patient interview by the resident, followed by a call to the preceptor to review the patient and make recommendations. The resident would then call the patient back to relay the information and complete the patient’s visit.

The COVID-19 pandemic also affected the job search in several ways. First, COVID-19 impacted securing jobs due to reduction of hospital budgets. First, CPNP Annual Meeting moved from in-person to a virtual platform which may have caused missed networking opportunities. Second, a financial shift was seen in hospital budgets due to COVID-19 resulting from temporary discontinuation of elective procedures and decreased hospital census due to fear of exposure to the virus.1 Elective procedures provide a substantial amount of income to many hospitals and this decrease may have limited the development of new clinical pharmacist positions across the country.2 A final change in the job procurement process was the transition from in-person interviews to distance interviews via video conferencing or telephone calls. While distance interviewing requires less travel and time away from residency duties, it also makes it more difficult to assess “fit” within an institution. Additionally, virtual interviews limit the ability for site tours. This year’s job search likely involved more phone calls, video conferences, and use of online job search engines than previous years, but many residents were able to overcome these obstacles and secure jobs within their specialty upon graduation from residency.

Another challenge during the pandemic was ensuring that residency requirements were met. The existing EMR and rapid implementation of virtual rounding enabled a relatively seamless transition for residents to continue to provide comprehensive medication management and ensure continuity of care. However, this was not without its pitfalls, as connectivity issues were possible and computers with video capabilities for rounding were not always readily available. Virtual topic discussions allowed for residents to broaden their knowledge and prepare for board certification examinations. While online conferencing applications made shifting resident education to a virtual platform relatively simple, completing patient education was more difficult. Pharmacy residents previously led patient education medication groups (PMEGs) on the inpatient psychiatry units, but COVID-19 disrupted this, in addition to individual patient counseling. Residents overcame this by converting PMEGs to worksheets which were printed and distributed to patients by nursing staff. For individual patient counseling, residents called patient units and counseled via telephone.

With regards to the requirement of managing formulary and medication-use processes, remote access to UNCMC’s intranet allowed residents ongoing access to the hospital’s formulary and medication-use protocols while offsite. This access also enabled residents to submit medication safety reports through the hospital’s online reporting system. While the hospital’s Pharmacy and Therapeutics Formulary Subcommittee met in person prior to March 2020, the transition to a virtual platform allowed the residents to continue participating in formulary management at UNCMC.

Research requirements were met through virtual meetings with project preceptors and remote access to data via UNCMC’s private network capabilities. The CPNP Annual Meeting’s virtual scientific poster session gave pharmacy residents a unique experience presenting their research.

Perhaps a residency requirement most influenced by the changes brought on by COVID-19 is the demonstration of leadership and teamwork skills in providing care for patients. It was not uncommon for the team pharmacist to be the only discipline not represented with an onsite presence during patients rounds and treatment team. This made interacting with members of the team and making recommendations challenging, but also encouraged residents to hone their skills in using effective communication styles.

The COVID-19 pandemic rapidly brought about many changes but has also provided an invaluable learning opportunity for teaching and learning. Namely, the importance of adaptability and openness to change were repeatedly highlighted. The need for structure and proper communication were also paramount. Though it is unknown how much longer these modifications will be necessary, it is likely that some changes will be carried forward into future practice, and therefore precepting in the era of the COVID-19 pandemic can still be a beneficial and successful experience for all involved.

References

  1. Khullar D, Bond AM, Schpero WLCOVID-19 and the Financial Health of US Hospitals. JAMA. 2020;323(21):2127. DOI: 10.1001/jama.2020.6269. PubMed PMID: 32364565.
  2. Best MJ, McFarland EG, Anderson GF, Srikumaran UThe likely economic impact of fewer elective surgical procedures on US hospitals during the COVID-19 pandemic. Surgery. 2020;168(5):962- 967. DOI: 10.1016/j.surg.2020.07.014. PubMed PMID: 32861440; PubMed Central PMCID: PMC7388821.
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